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UF physician argues that medical marijuana really isn't medicine

A vendor points out the variety of marijuana for sale at the grand opening of the Seattle location of the Northwest Cannabis Market, for sales of medical marijuana products, Wednesday, Feb. 13, 2013. The market hosts nine permanent vendors for seven-day-a-week sales, as well as a number of daily vendors of a variety dried medicines, edible products and starts.

Published: Wednesday, February 27, 2013 at 2:27 p.m.

Last Modified: Wednesday, February 27, 2013 at 4:04 p.m.

With medical marijuana now legal in 18 states and the District of Columbia, a national conversation is taking place that pits state laws against marijuana's federal prohibition and advocates of the drug for pain relief against those who say it's non-medical and dangerously addictive.

Dr. Gary Reisfield, the chief of pain medicine in the University of Florida's department of psychiatry, has weighed in on the debate with an article in the latest issue of the New England Journal of Medicine, in which he argues that marijuana should not be used in medical practice.

"It's not really the way physicians think; it's not medical, and it's not medicine," Reisfield said.

Reisfield's article was based on a case study of a female patient with advanced breast cancer experiencing severe pain in her spine — where the cancer had spread — along with nausea and loss of appetite. The woman lived in a state where medicinal marijuana is legal, so the question posed in the study was whether she should be able to take marijuana for pain and nausea.

"Many people would say, ‘Have compassion, let her smoke,'?" Reisfield said. "The bigger question is as a society what do we think about the use of smoked marijuana?"

Reisfield contends that precisely because the drug is smoked, it goes to the brain very quickly — which is partly what makes the drug both pleasurable and potentially addictive.

"We don't really have any examples of smoked medicine. If we have patients with pain, we don't recommend that they go out and smoke opium," Reisfield said. "So by the same token, it doesn't really make sense to say, smoke this plant, which has thousands of chemicals, and once you light it up, thousands more are released."

Furthermore, the effects those chemicals might have are relatively unknown, Reisfield said, especially since marijuana's status as a "Schedule I" drug, according to the federal government, has roadblocked clinical trials that might be able to clarify the drug's side effects.

Reisfield said the case study patient, with her already severely compromised immune system, could be at risk for developing a pulmonary infection from exposure to pesticides that might have been used to grow the marijuana plant.

Despite the absence of clinical certainties about marijuana's effects, anecdotal evidence shows promise for using it "for patients with certain kinds of pain and certain kinds of desperate situations," said Dr. J. Michael Bostwick, a psychiatrist at the Mayo Clinic in Minnesota, who wrote the counterpoint article to Reisfield's in the journal.

Bostwick said cancer, AIDS and multiple sclerosis patients might especially benefit as "people who are really needing something more than traditional medicine."

Bostwick added that patients typically use smaller doses that can relieve pain and induce an appetite without necessarily getting high. Pill forms of certain cannabinoids, the active ingredients in marijuana, are available, but are less effective than smoking would be, Bostwick said.

However, "I do not want to give the impression that this is a panacea," Bostwick said, adding that patients with the potential of psychosis and adolescents should not take marijuana for medicinal purposes because of the risk of addiction.

One in 10 adults risks addiction to marijuana, which rises to one in six for adolescents, Reisfield said, adding that legalizing it increases the risk of addiction — as well as the odds that the drug will fall into the wrong hands.

"My colleagues in California and Colorado tell me that the people who frequent medical marijuana clinics are males in their 20s and 30s, which really doesn't equate" with people who would most need pain control, Reisfield said, adding, "We know that legalization also leads to more abuse and dependence."

He said that with a quarter of Americans abusing tobacco and more than half abusing alcohol, "the question is why do we need to have to add another?"

But for Bostwick, the federal government's position "smacks of Prohibitionism."

"Maybe this will be the equivalent of gay marriage. The reality is that 18 states are already defying the American government," he said.

Maybe so, but that defiance shouldn't take place in a doctor's office, Reisfield argued.

"Patients' lives don't begin and end in doctors' offices. But I think it would be a mistake to medicalize this."

<p>With medical marijuana now legal in 18 states and the District of Columbia, a national conversation is taking place that pits state laws against marijuana's federal prohibition and advocates of the drug for pain relief against those who say it's non-medical and dangerously addictive.</p><p>Dr. Gary Reisfield, the chief of pain medicine in the University of Florida's department of psychiatry, has weighed in on the debate with an article in the latest issue of the New England Journal of Medicine, in which he argues that marijuana should not be used in medical practice.</p><p>"It's not really the way physicians think; it's not medical, and it's not medicine," Reisfield said.</p><p>Reisfield's article was based on a case study of a female patient with advanced breast cancer experiencing severe pain in her spine — where the cancer had spread — along with nausea and loss of appetite. The woman lived in a state where medicinal marijuana is legal, so the question posed in the study was whether she should be able to take marijuana for pain and nausea.</p><p>"Many people would say, 'Have compassion, let her smoke,'?" Reisfield said. "The bigger question is as a society what do we think about the use of smoked marijuana?"</p><p>Reisfield contends that precisely because the drug is smoked, it goes to the brain very quickly — which is partly what makes the drug both pleasurable and potentially addictive.</p><p>"We don't really have any examples of smoked medicine. If we have patients with pain, we don't recommend that they go out and smoke opium," Reisfield said. "So by the same token, it doesn't really make sense to say, smoke this plant, which has thousands of chemicals, and once you light it up, thousands more are released."</p><p>Furthermore, the effects those chemicals might have are relatively unknown, Reisfield said, especially since marijuana's status as a "Schedule I" drug, according to the federal government, has roadblocked clinical trials that might be able to clarify the drug's side effects.</p><p>Reisfield said the case study patient, with her already severely compromised immune system, could be at risk for developing a pulmonary infection from exposure to pesticides that might have been used to grow the marijuana plant.</p><p>Despite the absence of clinical certainties about marijuana's effects, anecdotal evidence shows promise for using it "for patients with certain kinds of pain and certain kinds of desperate situations," said Dr. J. Michael Bostwick, a psychiatrist at the Mayo Clinic in Minnesota, who wrote the counterpoint article to Reisfield's in the journal.</p><p>Bostwick said cancer, AIDS and multiple sclerosis patients might especially benefit as "people who are really needing something more than traditional medicine."</p><p>Bostwick added that patients typically use smaller doses that can relieve pain and induce an appetite without necessarily getting high. Pill forms of certain cannabinoids, the active ingredients in marijuana, are available, but are less effective than smoking would be, Bostwick said.</p><p>However, "I do not want to give the impression that this is a panacea," Bostwick said, adding that patients with the potential of psychosis and adolescents should not take marijuana for medicinal purposes because of the risk of addiction.</p><p>One in 10 adults risks addiction to marijuana, which rises to one in six for adolescents, Reisfield said, adding that legalizing it increases the risk of addiction — as well as the odds that the drug will fall into the wrong hands.</p><p>"My colleagues in California and Colorado tell me that the people who frequent medical marijuana clinics are males in their 20s and 30s, which really doesn't equate" with people who would most need pain control, Reisfield said, adding, "We know that legalization also leads to more abuse and dependence."</p><p>He said that with a quarter of Americans abusing tobacco and more than half abusing alcohol, "the question is why do we need to have to add another?"</p><p>But for Bostwick, the federal government's position "smacks of Prohibitionism."</p><p>"Maybe this will be the equivalent of gay marriage. The reality is that 18 states are already defying the American government," he said.</p><p>Maybe so, but that defiance shouldn't take place in a doctor's office, Reisfield argued.</p><p>"Patients' lives don't begin and end in doctors' offices. But I think it would be a mistake to medicalize this."</p><p><i>Contact Kristine Crane at 338-3119 or kristine.crane@gvillesun.com.</i></p>